Future of Chiropractic

New Information On 5 Actions To Change Clinical Practice

CF 131: New Information On 5 Actions To Change Clinical Practice Today we’re going to talk about moving toward being patient-centered. There are 5 actions recommended. What does it even mean? I might just ruffle some feathers here but a damn I do not giveth. But first, here’s that sweet sweet bumper music  
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #131 Now if you missed last week’s episode , we were joined by Dr. Kevin Christie with The Modern Chiropractic Marketing podcast and author of a new book that’s coming out on chiropractic marketing. Kevin is a rising star in chiropractic and is a must-not-miss. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Still climbing in the patient numbers. Where I’m located here in Amarillo, TX, there is a population of approximately 280,000 people. Last week, on Thursday and Friday we added 3 total cases of COVID on Thursday and only 2 cases on Friday. Then the following Monday, we added 11.  So, as you can see, the numbers here are no longer high. People are sort of ‘over it’ and you can see that and hear it when you talk to the patients. Hell, I’m sort of over it but still being smart. I’m having friends to the house again but we stay outside by the pool and have a couple of adult beverages.  I have a friend that is a musician. Last weekend, he played a rodeo on Woodward, OK. He said there were probably 1,000+ people at the event and it was indoors. So, in Woodward, OK at least, they are REALLY over it. No way in hell I’m grouping up with that many people indoor or outdoor right now. It just doesn’t make sense to me for now.  I guess if I were 28 and at the top of my game physically it wouldn’t make any difference to me either. But going to an event where people are yelling and cheering right behind, beside, and in front of me….big nopers right now. Ain’t happnin’ I noticed that while cases seem to be leveling off across America, they’re not increasing or decreasing as much as you’d like but, what I noticed is that the deaths are going down. Fairly signficantly. So wouldn’t that fit with the news that started coming out a couple weaks ago about the virus losing some potency?  People are still getting it but not as many dying from it. Another explanation could be that we’ve gotten better at treating it. Either way, that’s not my lane so I’m not going to act like the expert. I’ll just say hell yay-us and keep the good news coming so we can all get back to life as it was meant to be lived.  I hope you’re all well and staying healthy. As always, if you care about the kind of information I share every week and you listen consistently, I’m proud of you. I think you care about the right stuff and even though I don’t know you all, I consider you my friend.  Item #1 Let’s kick this week’s research reviews off with this one called ‘It is time to move beyond body region silos to manage musculoskeletal pain; five actinos to change clinical practice’ by Caneiro et. al(Caneiro JP 2020). published in British Journal of Sports Medicine in 2020. We got a hot one over here!! This paper actually has a lot of big names in the industry like Caneiro, O’Sullivan, O’Sullivan and Jan Hartvigsen. If you don’t know Jan’s name, you just haven’t been a regular listener.  Why They Did It They say that current clinical research, education, and practice approaches musculoskeletal pain and conditions in silos. Basically it’s a focus on body regions like the knee, hip, neck, shoulder, etc.  But current thinking actually shows that the pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability.  They say that a shift to focusing on the person is what is needed and that this would encourage the doctors to:
  1. focus on the patients’ context and modifiable biopsychosocial factors that influence their pain and disability
  2. Use education to facilitate active management approaches (targeted exercise therapy, physical activity, and healthy lifestyle habits) thus reducing reliance on passive interventions
  3. Consider evidence-based surgical procedures only for those with a clear indication and where guideline-based non-surgical approaches have been rigorously adhered to. 
Well who the hell can’t get behind all of that? Honestly, it’s odd when you think about it that in the year 2020, we’re still saying that surgery should be evidence-based and follow certain guides and that conservative treatment should be first basically. How’s that not just common sense and common procedure in 2020? We’re supposed to have freaking flying cars by now but the medical field doesn’t have this stuff down they way they should just yet?  It’s money. I know. I understand it. But it’s frustrating as hell all the same.  In this paper, the authors say to be truly patient-centered, they have five actions they recommend for managing a person with musculoskeletal pain, irrespective of body region. 
  1. Screen for biopsychosocial factors and health comorbidities. Notice this is #1 on their recommendations. If you’re just getting them in a pop a crack a lack and sending them on without this step, your results are going to be less than you or the patient desires. They say we need to communicate clearly with the patient to identify potential biopsychosocial drivers of the pain and then provide the therapy to fill that gap. These things include pain beliefs, emotional and coping responses to pain, social contest, physical and lifestyle factors and the presence of comorbidities. They recommend using the Orebro Musculoskeletal Pain Questionnaire. 
  2. Embrace patient-centered communication. This one is huge and this is one of the key things we learned in the Fellowship training for the neuromusculoskeletal medicine program. Clinicians should use open and reflective questioning to elicit the patient’s understanding of factors, which include the pain experience (tell me your story), causation beliefs (what do they think is the cause of the pain?), coping (what do you do when the pain increases?), impact (Tell me how your symptoms affect your ability to move and function), concerns (do your symptoms worry you?), beliefs (why do you think you shouldn’t bend/lift, or run?), social factors (tell me about your home life or work life), goals (what are you rgoals?), and expectations. Yes, to an extent, updated research and thinking has us behaving a bit like a psychologist I think. It’s not my favorite stuff. But, when you learn and consider how much pain is held in the brain due to these yellow flag indicators, then you start to realize that pain, certainly chronic pain, cannot just be treated at a peripheral source. You have to address the pain from a central sensitization perspective at least equally or you risk never being able to help these patients. 
  3. Educate beyond words using active learning approaches. doctors have to embrace education as a central part of patient care if we are going to change behavior. We have to dispel myths about pain, imaging findings, and activity engagement (for example, hurt does not equal harm). They say that behavioral learning like exercise therapy can be used to bust myths that are unhelpful. Myths and beliefs that lead to things like fear avoidance. 
  4. Coach towards self-management. A large portion of the chiropractic profession wants and desires patients to depend on them week after week, month after month and that’s just not real world stuff. And it’s not helpful for the patient’s recovery either. We should be empowering patients to engage in exercise, valued activities and a healthy lifestyle with confidence. Can you feel the difference here? “Mary, I know you’re only 35 but you already have some degenerative discs in your neck and I’m so concerned about it. This should be considered urgent and I’m going to need to see you 5 million times for the rest of your life.” Is that helpful or is this helpful? “Mary, I know you read on your rad report here that there is a finding of a degenerative disc in your neck but the truth is, that’s very common and not something you should be concerned with. Certainly not over-concerned with. I actually prefer the word ‘deconditioned’ over ‘degenerative.’ A good percentage of 30-40 year old patients have some mildly deconditioned discs but these rarely ever cause any issues. You’re young, you’re strong, and you’re healthy. We’re going to get everything moving correctly and then I’m going to give you some excellent exercises to really focus on the region and build plenty of support. You’re going to do great.” When you stack those two next to each other, it’s easy to see how harmful one is as opposed to the other more positive, more hopeful one. I got a little side tracked there, the point is, help them take control and self manage. Active amnagement relieves pain and improves function across pain conditions and health comorbidities. 
  5. Address comorbid health factors. They say clinicians should refer for co-care in teh presence of comorbid mental and physical health complaints like high levels of emotional distress, eating disorders, and type 2 diabetes. The authors say they contend that multidisciplinary care needs to be integrated, with consistent messages across the team to prevent care fragmentation and patient distress. 
Wrapping up the paper, the authors say Patient-centered care will optimize the value of healthcare provided. Shifting funding to support high-value evidence-based care options and educating society will be critical to enable this transition and will likely be cost-effective. Integrated cross-discipline clinical networds are required for effective co-care. We believe clinicians are ready to change, but they require the support of health systems and payers.  One word….two syllables. Day-um. You day-um right. But, health systems and payers are stuck on the part of our profession that doesn’t care about movement, function, yellow flags, exercise, or proper patient-centered practice. They’re stuck on the portion of our profession that is TIC or TOR or principled or whatever the hell useless drivel they’re using this week.  The hardcore, philosophy, doctor-centered, faith-based rather than evidence-based group of chiropractors are smaller but they’re so much louder. And dangerous. They’re flat-earthers. They’re the reason the evidence-based group will never reach any kind of cultural authority.  You can have a GROUP of guys and girls go through years of continuing education and maybe get a couple of diplomats in neuro or orthopedics or rehab….wahtever….and they can be the smartest chiropractor on the planet and almost 100% of their patients get well.  And then you have just ONE lowsy-ass guy or girl go and bait and switch just ONE patient into 80 visits in a year with a contract and all of the bells and stupid whistles of a doctor-centered practice, and that group that worked so so hard loses every ounce of legitimacy. Because of ONE jackhole that refuses to understand or read research or refuses to sacrifice some money in the interest of their patients well-being.  It’s gross. It’s awful. But it’s chiropractic. We are already looked at with a side-glance untrusting gaze. So any deviance of behavior that would be widely considered normal is magnified. Just one ruins the batch for all of us.  I remember a preacher once saying that you gain trust in drops but you lose it in buckets. The reality in chiropractic is that just one faith-based, doctor-centered jackhole loses trust in ALL chiropractors in buckets. For ALL of us.  My plea is to start sharing this podcast with your subluxation friends. Especially the young students that haven’t yet decided to be ‘principled.’ Maybe we can help lead them down the right path from the very start. The more people are exposed to the research and to the idea of being patient-centered, the more they’ll latch onto it. They have to. One is borderline evil, and the other is not. It’s backed by science. One destroys reputations for the sake of the dollar. One builds reputations and respect. One is built on ideas and theories over a century old that cannot or have not been proven while the other is backed by science and progress. How is it even a damn choice to begin with? We’re either a healthcare profession. Or we are a faith. True healthcare professions do research and then they do more and they change according to what works well and they drop the stuff that doesn’t, and on and on to the point of really being on the cutting edge of the science and on the health of our patients.  I’ll never understand how such a percentage of our profession can’t get on board with that. Whatever the answer to that question might be, it’s that answer that keeps us at the bottom of the cultural authority ladder.  Unfortunately, I don’t see if changing any time soon. Not until the governing boards decided it’s time to change once and for all.   Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Caneiro JP, R. E., Baron CJ, et. al., (2020). “It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice.” Br J Sports Med 54: 435-443.

w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic

CF 127 w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic

Today we’re going to be joined by Dr. William Morgan, President of Parker University and over-all impressive human being.  But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it.  You have found yourself smack dab in the middle of Episode #127 Now if you missed last week’s episode, we talked about immunity-boosting, coconut oil failures, and screen time and its apparent association with autism. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  When we have a guest, we typically dispense with my personal thoughts and practice experiences over the course of the week. We will do that same this week outside of this; I was with many of you. I closed the shop for 2 weeks. Solid. Closed. Then, I gradually started back with urgent/emergent care just like our governing board in Texas recommended.  At this point, I’m in my 3rd week of being completely re-opened. Even to wellness and maintenance care. While I’m used to 180-220 patient visits per week, I’m now experiencing about 110-120. We’re low. Obviously. But, it’s growing every week. People are beginning to tire of the restrictions on their activities and, I’d assume to some extent, are becoming somewhat numb or less concerned…..or more comfortable I guess with the risk aspect of it all.  Regardless, they’re starting to return. I’m pretty sure those of you that closed and did a gradual re-opening like me are experiencing much the same. Now if we can get the massage therapists back to work safely. We’re still waiting to see what happens on that end of it.  OK, let’s get to our guest today. I tell you sincerely, we are hitting the high spots on this show. WI’m just sitting here thinking about all of the amazing guests we’ve had over the last three years and just in the last few months we’ve had Dr. Stu McGill, Dr. Mike Massey, and now Dr. Williams Morgan. It’s been fun to watch this thing of ours grow and continue to grow. You, the listener, is the main reason for that growth and I just want to continue to thank you and tell you how important you are to me and how much I appreciate you.  Usually, bios and intros can be a bit mundane. Not today, my friends.  When your guest has been the chiropractor to the US Congress, the US Supreme Court, and to the White Hosue, well, you know it’s going to be a good one don’t you? Not only that but Dr. William Morgan, as mentioned, is the President of Parker University, and an active member of the Texas Chiropractic Association and has been testifying on chiropractic issues in the last two Texas Legislative Sessions and is happy and proud to be a Texan. That’s my kind of guy right there!! Our Texan pride is indeed legendary and probably annoying to anyone outside of the state.  At age 17, he joined the Navy and served with an elite Marine Recon company as a hospital corpsman. During that time, he qualified in parachuting, military diving, submarine insertion, jungle warfare, combat swimming, explosives, mountaineering, winter warfare, and Arctic survival. Additionally, he attended anti-terrorist training at the FBI Academy. After leaving active military service and transferring to the Navy Reserves, Dr. Morgan began his educational journey to become a doctor of chiropractic. While at Palmer College of Chiropractic-West, he transferred to a Naval Special Warfare platoon as the unit’s primary hospital corpsman. He was sent to Special Operations Technician training to learn the principles of dive medicine. For the next eight years, he served as a dive medicine corpsman/combat swimmer for a platoon of Navy frogmen in Naval Special Warfare Unit One.   In 1985, Dr. Morgan received his Doctorate of Chiropractic from Palmer College of Chiropractic–West and soon after, married fellow Palmer graduate, Clare Pelkey. They practiced for thirteen years in California. In 1998, Dr. Morgan was chosen to establish the first chiropractic clinic at the National Naval Medical Center in Bethesda, Maryland, which later became Walter Reed National Military Medical Center. In 2015, Walter Reed recognized Dr. Morgan with its highest honor for clinical excellence, the Master Clinician’s Award. During the last 18 years at the military’s most prestigious medical centers, he practiced in an integrative setting, providing chiropractic care to the injured troops returning from the wars in Iraq and Afghanistan.  In the year 2000, Dr. Morgan was appointed as the Chiropractor to Congress at the U.S. Capitol. At the Office of the Attending Physician to Congress, doctors of many specialties care for members of Congress and the Supreme Court. In 2007, Dr. Morgan began serving as the White House Chiropractor. He was appointed chiropractor for the United States Naval Academy football team in 2009 (which never lost to Army while under his care).  In 2011, Dr. Morgan was appointed to the United States Navy Musculoskeletal Continuum of Care Advisory Board, an entity created to address the prevalent injuries sustained by U.S. Armed Forces Personnel during active-duty operations. Dr. Morgan also served on the Spine Subcommittee, which helps develop care algorithms for treating spinal conditions and determining the future of musculoskeletal management in the U.S. Armed Forces.  Dr. Morgan has completed a 2,000-hour residency in Integrated Medicine. He served on the Board of Trustees for Palmer College of Chiropractic for ten years. He is a Diplomate of the American Academy of Pain Management and has held adjunct faculty positions at F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and New York Chiropractic College. Additionally, Dr. Morgan served as a consultant for the U.S. Department of Veterans Affairs (VA), helping to implement the VA’s chiropractic benefit and advocate for chiropractic research  Parker University inaugurated William E. Morgan as their seventh President in 2016. Upon arriving in Texas, he became an active member and supporter of the Texas Chiropractic Association (TCA). Almost immediately, he organized a leadership summit to establish a legislative agenda strategy for chiropractors in Texas. Texas Chiropractors had not won a significant legislative victory in two decades, but in 2017 four bills advantageous to the chiropractic profession passed. Additionally, Morgan has assisted in fundraising, membership recruitment, and awareness for the TCA. As a lifetime member of the American Chiropractic Association (ACA), he has also held several leadership positions in the organization.  Just last year, I was at the TCA President’s Gala when Dr. Morgan was awarded the Keeler Plaque which is awarded to the chiropractor of the year but is also a life time service award of sorts. It’s the most prestigious award the TCA gives so it’s quite an honor. And here in Texas, we are quite honored to have Dr. Morgan on our team. As a side note, I’m honored to know Dr. Morgan personally and really appreciate him agreeing to come on this podcast so let’s hop into it.  Welcome to the show Dr. Morgan, thank you so much for caving to my pestering and agreeing to shut me up by finally coming on the show.  Having the background you have, you’ve spent serious time on both coasts of our great nation. Now you find yourself dead center, right in the middle of the country. What was the allure of Texas for you, how has Texas treated you, and what has been your favorite thing about living here in Texas? Did you have any early perceptions of Texas or Texans when you moved here that proved to be false and did you have any that proved to be absolutely true? Everyone has a chiropractic story, what led you to want to be a chiropractor? Can you share a little about how you got to the point of climbing the ranks and becoming the chiropractor to Congress, the Supreme Court, and the White House? How did it all come about? Can you share some of the legally shareable and more unique stories or experiences of treating those types of patients? You moved to Dallas, TX to take the helm of Parker University as their 7th President. Just a little background on me personally, I was there when Jim Parker was still around. I was there when he passed away and his son Karl took over and I believe Fab Mancini was coming on board about the time I graduated. I’m well acquainted with Parker of yesteryear. When you got to Parker, what was one of the first things you wanted to change? What would you say has/have been the changes you’ve made since arriving that you are the proudest of? When I was in school there, exercise/rehab honestly was not a big aspect of the curricula. I know a bit about you and Parker Fit. Have exercises and rehabilitation taken on a larger role since 1998? Some areas of the country never experience something you all, unfortunately, went through last year. Tell us a bit about the tornado, the aftermath, and going forward from it.  Now, from one awful event to another. Our current global pandemic. How is Parker University handling this event? What can students expect going forward? During this crazy time, there have been a lot of divisions in the country from opening vs. closing to ‘I refuse to wear a mask’ vs. ‘can you please wear a mask’? Our profession, unfortunately, is no different. It’s been divided along clear lines for decades and this pandemic has brought some of the divisions into the spotlight. One of them is between those that promote spinal manipulative therapy as a way to boost immunity and those that do not support that. When this was really first unfolding and our Texas Board of Chiropractic Examiners, the WHO, the WFC, and the ACA were all telling chiropractors the support for immunity boosting is not present in the research literature, you and Dr. Katie Pohlman (I love Katie and need her on the show BTW)…you and Dr. Pohlman recorded a very smart and well-stated video saying that indeed, the research literature cannot support immunity-boosting at this time. Obviously, I was and am 100% on board with it and I said all of that to ask you this, was there any fallout to that? How did you handle it? And what went into the decision to record it in the first place.  Let’s move to legislative issues. What have you felt is our biggest issues in Texas and on the national level when it comes to chiropractic?  I have said repeatedly on this show that due to the opioid crisis and due to the emerging research over the last 5-10 years, I truly feel there’s not been a better time to be a chiropractor since the 1980s. As the President of a chiropractic college, what is the status of our profession right now? Not just in terms of the pandemic but over the course of the last year. Over the course of the next 5 years. Am I right about it being a great time? Am I wrong? Or a little bit of both? Thank you for joining us today! Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website http://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger      

What Makes A Good Chiropractor – 9 Characteristics

CF 101: What Makes A Good Chiropractor – 9 Characteristics

Today we’re going to talk about going to a chiropractor and how to tell your out-of-town loved ones how to choose a good one on their own. Without your help even! We’re also going to talk about being the kind of chiropractor that your colleagues are happy to send their family to. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. We’re not the stuffy, high-brow kind of research oh no…. we’re talking about research over beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  If you haven’t yet I have a few things you should do, like our facebook page, join our private facebook group and interact, and then go to chiropracticforward.com and check out the store link. Sign up for our weekly newsletter there too.

No spam there, just reminders when we post a new episode so you don’t miss any!

You have collapsed into Episode #101

Now if you missed last week’s episode, we covered a lot of research. It was Episode 100 so make sure you don’t miss that info. 

I know there were some good solid knowledge nuggets found there within so make sure you’re up to date and not falling behind the rest. Keep up with the class, man! 

On the personal end of things I cannot tell you what a trying and what an emotional week it’s been. These episodes are recorded a week or two ahead of time so you’ll note the time difference of when this happened and when it’s making its way live. 

On Saturday November 9th, my dad had a stroke. He got out of bed that morning and said he’s got a tall bed so he always has to sort of find his footing before he gets out and walks. He said on this day, he got out of bed and got out a bit awkward and fell. 

He hit his head on the end table and cut his head open. From there, he went to the garage to get rags to clean up the bloody mess. Well, from the garage he goes to talk to his wife in the kitchen and there he falls again….hitting his head once again. 

At this point, his wife calls the ambulance and off to the hospital they go. My wife and I were in Dallas TX, about a 6 hour drive away. So, I get the call. Take care of my business in Dallas and head back to Amarillo as quickly as we can. 

Now, never having been around a stroke victim in the first week or so, I have little experience in this arena. I had no idea what to expect. When we got to the hospital, he was awake and talking to me. Telling me all kinds of stories, basically doing decent but there was weakness on the left side arm and leg. 

Now, here’s where it got A LOT more interesting. On day two in the hospital, after taking a walk on the walker, he was sitting and eating and just relaxing when he had stroke #2. This was the more severe stroke. They put him on heparin, a blood thinner, and took him to the critical care unit to keep a closer eye on everything. 

Now complete loss of sensation and motor in the left leg and arm and hand. He was very out of it and confused in the CCU. 

So that was touch and go for a bit as you can imagine. Very emotional. Very stressful for everyone. Certainly for my dad. 

Now, let’s fast forward to today, Monday November 18th, we are now 9 days out from the first stroke and 7 days out from the second stroke. He’s out of the hospital and in a rehab facility where they are trying to teach him to regain his life if possible. At this point, nobody knows where this train is going to take us and when it will get there but, we are hopeful and we are praying. If this reaches you and you hear it, I would appreciate your prayers, your good vibes, or whatever you are willing to send this way. 

He could use it and, honestly, his family could too. It’s been a challenge to try to see patients and then spend time at the hospital. It’s hard to be present for your patients when your mind is fixated on your personal problems. I’m sure it goes that way for doctors going through divorces and life changing events like that as well. Mine just happens to be my Dad’s stroke. 

So, I’ve usually got at least something to share with you on the personal side of things. This one was a whole new thing for me. I’ll probably giving updates as we go along. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

Now, the reason for this week’s topic: I saw a question on one of the Facebook groups the other day about what are the qualities we look for in other chiropractors before we’ll recommend them to a family member or to a friend. 

Quite honestly, I get phone calls, text messages, Facebook messages, and emails from friends and associates that live out of town asking me if I know a good chiropractor where they live all of the time. Literally almost every week. And if I don’t know one, then what is the best way to choose a chiropractor? I’d say my first knee-jerk response is to go to forwardthinkingchiro.com and check the Member Map they have. 

Now that still doesn’t guarantee it’s the best referral in the world but it’s a damn good start in whittling out the crazies right off the bat. But, that map unfortunately doesn’t represent every area of every city and it certainly doesn’t get you a good referral in BFE, Wyoming. 

So, that’s what we’re talking about here. How do you find someone then if that FTCA map fails us?

I think that any time one decides that they’re going to go to a new doctor….even for you and for me…..If we change doctors, there is a certain amount of apprehension. In choosing a chiropractor, this apprehension can be escalated to a certain extent because all chiropractors are vastly different. In short, there is literally zero standardization. It’s like the wild wild West out there. If you have an ear infection and you go to the ER, you know it’s going to be a pretty standard treatment, right?

Not with chiropractic. You can go in for a little tweak in your back and walk out $3500 lighter with a year long plan. Or you can walk in with a little tweak in your back and get some completely normal, repsonible recommendation. 

There are some chiropractors that focus on weight loss. There are some chiropractors that only use an instrument to adjust rather than manual adjusting. 

There are some chiropractors that are more driven by philosophy than other chiropractors. There are some chiropractors that use therapy and extra equipment, while other chiropractors only adjust.

So let’s dive into 9 characteristics I feel are important in a good chiropractor. 

  1. 1. Honesty 

Other than the first topic and the last topic, I have not put these qualities in any specific order. But I put honesty at the top of the pile because I feel that strongly about it. 

I feel that honesty is of utmost importance in any profession. Especially in the healthcare field. People are literally putting their lives and their livlihoods in our hands. You would like to think our family is putting their lives in the hands of an honest person, don’t you think?

We’ve heard it said time and time again that if a person doesn’t have his word, then he doesn’t have anything. It so so true. 

How do you know if a chiropractor is honest when you first visit their office? That’s a hard one to answer. It may simply be a “gut” sort of thing. But usually, if we trust our “gut”, then we don’t get steered off of the right track.

You may not be able to develop a “gut” feeling until the second or third visit but you will most likely get a good idea by then. I would say that, in general, if it takes 3 visits to get your recommendations and really start treating, they may be using sales tactics on you. 

If they talk about having to see them once a week for a year or for a lifetime, they may not necessarily be dishonest but they are most certainly unaware of current guidelines and evidence-based protocols. 

If they talk about fixing everything in your body based on a subluxation model, I’d say you should save your money and leave. That’s just me. Again, that doesn’t mean dishonesty but it does mean they may not be evidence-based. 

  1. 2.Evidence-based/Evidence Informed 

OK, this one is admittedly a sticky one here. As most chiropractors are well-aware, there is this huge chasm in our profession between those that believe in only adjusting the spine and nothing else and those that are evidence-based or evidence-informed. 

Between those that follow a philosophy and those that follow research. Between those that do not believe in the profession progressing and growing and those that believe our profession can and should grow and expand. 

There are some research papers that the philosophy group will point to saying these papers prove their theories and minimal treatment but, in truth, from what I’ve seen, they are low quality and no profession worth anything would rest their entire reputation on them. 

However, there are TONS of papers, many of which we have covered here on the Chiropractic Forward Podcast, that proves and validates evidence-based chiropractic every day in almost every way. 

In general, it is my recommendation that you BE the chiropractor or refer your family TO the chiropractor that follows research, follows the expanding knowledge within, and pushes to move the profession more and more into the current century. 

  1. 3.Network. 

To me, “Network” means, “how plugged in is the doctor as far as his associations, his colleagues, and the profession as a whole?”

On the surface, that may sound like a silly suggestion and to be somewhat inconsequential to you. But I have found that there is an extreme amount of value in being active with fellow chiropractors and state and national associations. 

We are able to bounce ideas and questions off of each other whereas someone with no colleague interaction or support system merely has their own knowledge and is sort of on an island of their own making.

Trust me, this is coming from a dude that was on that self-made island years and years ago. I had my basic knowledge from going to chiropractic school but I wasn’t particularly skilled in anything extra. Just basic white paint in a world of oranges, purple, fuschia, lilac, or whatever color you can think of. Sitting here today, I wouldn’t send anyone to me then. 

Being active in the Texas Chiropractic Association has allowed me the opportunity to stay plugged in with rules and regulations, new treatments, changes in insurance plans, and options that I would have likely never known about were I not being active in my profession.

  1. 4. Knowledge & Experience of Doctor and Staff

I think this qualification really goes without saying. And again, knowledge and experience is of extreme importance in ANY profession. Even an experienced comedian is usually going put on a better show than a rookie.

For instance, I attend a chiropractic conference one weekend out of every month. Chiropractors are required 16 hours of continuing education every year. Some chiropractors will only go to a continuing education seminar one weekend out of every year. I should know, I used to be one of those chiropractors. 

But with age comes wisdom and the desire for more wisdom. I would do my best to figure out the chiropractor’s knowledge and their level of experience. This could certainly end up being a “gut” thing as we previously discussed but it’s usually something they’re proud of and something they market. 

Trust me, when I finally get that Fellowship of the International Academy of Neuromusculoskeletal Medicine, you better believe it’s going to be on the website and will probably look like some sign right out of Las Vegas.

If there’s no sign on the website of extra certification and acheivement, your money is probably best spent elsewhere. I’m ten times the doctor I was when I began the Diplomate program. Or more….exponentially better. 

  1. 5. Good listener 

You’re not going to be able to get this off of a doctor’s website so don’t even try but we can strive to be better ourselves in this department. Myself included. I’ve been at a point where I didn’t feel I could get everyone worked through in one day and I can guarantee you I cut some patients off in the middle of their explanation. 

I think that it is very important that a doctor has a good bedside manner. Meaning, that they need to be able to listen, focus on the patient, and fully understand what the patient is saying and what their concerns are. There are those days where we are just doing everything we can to stay above water but in general, don’t be uninterested and think you have the problem solved before they’ve said anything. 

Open your ears. 

  1. 6. Office Presentation. 

This may seem like a silly one and I’m sorry if it’s just not important to you, but if I am going to a doctor’s office, I expect the office to be mostly clean and fairly sharp looking. 

GASP….what if they went over the top and it looks amazing? 

I think that if a healthcare provider takes pride in their office and in their staff, then they’re going to take pride in their results and their expertise. Maybe I’m wrong. You can find those that don’t give a squat about anything in their office. No good pictures, old this, smelly that..yet they’re able to get the best results. 

Let’s face it though, is that the exception or the rule? I argue it’s the exception.

An an ideal office, they try to have a welcoming feeling, the staff is dressed neatly, there is as little dirt or dust is on the floor and furniture as is possible, there is no trash on the floor next to the trash can, everything is as nice, as sharp, and as clean as possible. 

If the doctor and the staff do not portray an acceptable image, then that may not be the place for you.

  1. 7. A sense of purpose. 

Have you ever gone to a doctor’s office and felt that they were simply going through the motions and collecting money? I have absolutely felt that way a time or two. I think that the better doctor is genuinely concerned about his patients’ well-being, and how he can help them in the best way possible.

Someone that you can just feel is a little extra. Someone that is knowledgeable and can relate things to you in relate-able terms. Not chiropractic jargon. Someone that you can instantly tell is not there to get into your pocket or to max your insurance. You know what I’m talking about. Someone that is there to get you results as quickly as possible. That’s purpose. 

Even on top of that though, it would be nice to find a chiropractor that you felt had the community’s best interests in mind. When you see them donating and giving back to their community, why wouldn’t you want to do business with that person instead of a taker. Takers kind of suck. Takers just make profit but are narcissistic. They don’t get involved with their state or national associations at all. They don’t give anything back to their profession, their school, or their community. 

They take that money and spend it only on themselves because that’s all they care about. I don’t want to do business with that person. I want to do business with a giver. Any day all day. Gimme a giver. Thank you, i’ll have another please. 

I want a chiropractor that got into the profession of chiropractic in order to heal people. And to heal as many people as he could possibly reach. 

Someone that thinks and works on a higher level rather than someone that just shows up to work and does their job. A doctor that is excited and jazzed to be doing what they’re doing in the place where they are doing it. 

THAT’S the guy I want to go to!

  1. 8. Know when to refer. 

Tell me you know when to refer. Tell me you don’t think you can fix everything. Please tell me!!

When we talk about referrals, we can get way off track in the chiropractic profession. Some chiropractors feel they can solve any problem walking through their doors. Ear infection? Pop ya bones? Asthma? Pop ya bones. Cancer? Pop ya bones. Diverticulitis? Pop ya bones? 

You know the ones. Yeah you know them. They’re the reason people in the medical field look at all of us like we’re crazy. And if that’s the measuring stick for crazy, then they’re right. Fortunately, most of aren’t like that. But the loud minority is still winning the day in our profession I’m afraid. 

As I said before, I am interested in the chiropractor that is plugged in to his profession and to his colleagues. I’m interested in the chiropractor that is plugged in to the healthcare field as a whole. And I’m damn sure interested in the chiropractor who is plugged into research and current, accepted guidelines. 

If a doctor gives me a sense that they feel that they are the only one that can handle any condition, or that there is never any need to look outside of their office for additional help, then I am likely going to find another chiropractor. I think it is extremely important to go to a chiropractor that is not afraid to admit when additional treatment should be reasonably looked at.

I for one, look forward to each and every time that I have the opportunity to work in conjunction with a medical provider. I feel that it is a very complete treatment plan when you are able to address all symptoms thoroughly.

Patients have to take into consideration whether they  want a chiropractor that is deeply versed in chiropractic philosophy or want a chiropractor that is open to working with the medical community. 

  1. 9. Love. 

I like to throw curveballs here and there. I like to add things you don’t see in most lists. This is one of those things and I saved this one for last because I hope that, after you’re done reading this, this is the one that will resonate the longest with you. 

I strongly feel that when you visit a health care provider,  things like caring, genuineness, focus, listening, and all of those other things that we’ve talked about above…..they can all be wrapped up into one thing. 

And I think that that one thing is love. If the doctor and the staff love what they do, they love their patients, and they love being where they are, when they are there, then people can feel that.

If you walk into an office and it’s cold, there’s no personality, and it feels stiff and stale, then that’s just no fun at all. Where’s the love? How do you show it to your patients? 

I want an office that I love to go to and if the doctor and the staff have love as the primary driver of their office and their purpose and it’s something palpable that you can feel….., then I think that all of the other eight qualifications pretty much take care of themselves.

That’s it. I’m sure if I didn’t have so much on my plate I could come up with about 20 more things that are important. Maybe a 100 but I have to get to the hospital to see my dad. 

I enjoyed sitting and throwing some random thoughts on the page. I hope you liked it and make sure you come back next week. 

Our podcasts post every Thursday. Typically in the morning unless I’

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

w/ Dr. James Lehman (Pt. 1) – National Scope, Chronic vs. High Impact Chronic, Coordinated Care/Medicaid, DACO to DIANM

Today we’re going to be talking with Dr. James Lehman. Yes, THE Dr. James Lehman and we are fortunate to have him with us. The experience and the common sense Dr. Lehman brings to the table is immense and I can’t wait to dive into it today. We’re going to talk about national scope

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #96

Now if you missed last week’s episode on chiropractic and opioids, on anti-inflammatory diets, and on screen time for kiddos…. make sure you don’t miss that info. Go back and listen. I think there were some good information there within so make sure you’re up to date and not falling behind the rest. 

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We can’t get started without mentioning the sponsor of the show, 

It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. We could go on and on. 

Welcome to the show Dr. James Lehman, it’s an honor to have you on the Chiropractic Forward Podcast this week. 

Let’s start with the topic that immediately impacts me. I have been telling our listeners for a year or more that I’m going through the DACO program. DACO stands for the Diplomate of the Academy of Chiropractic Orthopedists. Very recently, as in just a few weeks ago, I received notice that the designation has changed to DIANM which stands for the Diplomate of the International Academy of Neuromusculoskeletal Medicine. 

What was the impetus for the change and what all went in to making the decision, deciding on the name, and then moving forward with the decision?

You wrote an article recently that Dynamic Chiropractic published in their September 2019 issue. The title of it was “What Is Chiropractic? We Need A National Practice Act.” We are in a profession that seems to me to bristle at the idea of standardization. How has this article been recieved or is it still a bit too early to tell?

In the article, you say, “Limited Medicare and Medicaid scopes of reimbursement and individual state scope-of-practice restrictions reduce access to chiropractic wervices for patients in pain.” Can you explain how you think limited scopes reduce access and how a broader scope can help us? And how broad of a scope do you advocate for?

I would assume a national scope would be something the ACA would be in the driver’s seat for, which is something you mention in the article as well. Is this something the ACA is looking at? Other than resistance within our own profession, what hurdles would you see in the way of a national scope?

You say it’s not impossible to accomplish and offer 6 essential charactieristics which include:

  1. Chiropractic Physician designation. 
  2. The scope being determined by Doctoral and Post-Doctoral education, trainng and experience 
  3. Full management, referral and prescription authority commensurate with contemporary chiropractic education for patient examination, differential diagnosis, working diagnosis, and health assessment
  4. Full evaulation and management, referral and prescription authority commensurate with contemporary chiropractic education for the care and treatment of neuromusculskeletal and other health conditions or issues. 
  5. Full authority for the delivery of information, advice, recommendations and counseling regarding general health matters, wellness, and health optimization. 
  6. Full authority and adaptable requirements fo the management and training of health care teams and the participation in collaborative or integrative health care groups. 

When I read through that list, does anything jump out at you as being particularly radical or provocative to some chiropractors?

In your article, you include a section titled “Modernization of Medicare and Medicaid Coverage” which will lead us nicely into one of the main topics of our episode today. In this section you mention how Article 2706 of the Affordable Care Act is supposed to prevent discrimination against chiropractors but, for whatever reason, it hasn’t. I’ve been hollering about this through my position with the Texas Chiropractic Association for years. You talk about this a little in the article but…..why do you think nobody is forcing 2706 down people’s throats and what would it take to take a stand against insurance companies with 2706 as the basis?

OK, coordinated care and Medicaid: a topic you are very knowledgeable. In fact, we have discussed the integration of chiropractors into the FQHC’s around the nation. FQHC, for those that don’t know means Federally Qualified Health Centers. One of our former podcast guests is Dr. Kris Anderson from North Dakota who just happens to be the first in his state to work in an FQHC. 

Can you tell us more about coordinated care and Medicaid and the initiative to get chiropractic care integrated more into that setting?

Alright, last on our list of things we must talk about is the topic you have done a ton of work on. I remember one of the DACO classes I had with you as the instructor. In the class, I recall you mentioning that we as a profession do not diagnose chronic pain syndrome nearly enough. It’s a big problem, and one I’ve become more and more engaged in through the DACO program, so let’s dive into the topic of Chronic Pain Syndrome vs. High Impact Chronic Pain. 

I’m just going to turn it over to you on this. The way I want to start is for you to just tell us what you think we as a profession need to know and we can take it from there. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

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Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

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Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Healthcare Of Old – Days Gone By

CF 090: Healthcare Of Old – Days Gone By

Today we’re going to talk about how healthcare has changed – gone are the days of this and gone are the days of that. And there will be plenty of room for me to spread some personality in there too. If you’re a regular listener, you know I’m never lacking an opinion. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #90

We can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

We have some great stuff this week. It’s a short week due to Labor Day so this episode may run a little short and that’s OK. I try to not get too long winded. I think I went on about 45 minutes when we talked about Closing Patients two episodes ago.

But, a little gripe session never hurt anyone. If you’ve ever wondered whether Closing patients is right or wrong, get my take by going and listening to episode #88. I lay it out pretty clearly there. 

And don’t forget, last week’s podcast about Fibromyalgia. New info on fibro and treatment. Good stuff there in episode #89

Item #1

I want to start with an article that kind of struck me as…..huh….interesting. It’s called ‘The Old Days of Medicine Are Gone” by Michael Weiss(Weiss M 2019) and it was published in MedPage Today on January 17, 2019. Hot potato, heads up now. 

Weiss is a cardiologist and I have cited this article in the show notes over at chiropracticforward.com. This article refers to medical doctors specifically but there are a lot of parallels that we doctors of chiropractic can relate to. 

The article starts by saying that in the last 5-6 years, physicians have become less and less powerful. So have their patients. This disempowerment is due to a lot of things according to this article. Chief among them are:

  • Health management organizations
  • Managed care and 
  • The insurance exchange

Mr. Weiss says that all of these factors have taken power from the doctors and put the power into the hands of the large insurance companies and in the hands of the government. Well, that’s been going on for at least a generation. 

I remember a pencil pusher with an insurance company several years ago, a person who doesn’t have any kind of degree other than following prompts on a computer…..I remember them telling me how to treat a patient. What they needed. How many times….I was stunned. I will just say that I had a strongly worded conversation that I’m certain went in one ear, bounced around in that dude’s empty noggin, and fell out the other without making any impact. 

But I remember thinking, we are allowing insurance companies, the guys with a financial stake and a financial bias, we are allowing these people to tell us how and when to treat patients when they’ve never seen them in their lives. These patients are just numbers on a page to these companies and they’re going to tell us how to treat them. 

Same goes for the government. Whether it’s a popular opinion or not, makes not one damn to me. I’m going to tell you that when you put all of your healthcare decisions in the hands of one big fat, red-taped fat bureuacratic entity that has already screwed up Medicare and Social Security for no reason at all, due to both sides of a messed up aisle, well, you are once again numbers on a page and sometimes you get what you deserve. Of course that doesn’t mean everything’s peachy and we don’t need some changes to the healthcare system. We most certainly do. Universal healthcare medicare for all though…..I don’t see how that is the solution. Again, one fat, slow, dumb entity that has a history of screwing up big programs isn’t what I personally want making all of the healthcare decisions for me and my family but to each their own. 

Getting back to the article, Mr. Weiss says this physician disempowerment was basically a money grab on the parts of these powers and on the part of the pharmaceutical industry. Well…..of course. I think all that goes without saying doesn’t it? But I’m glad someone is indeed actually saying it. We should be shouting it out loud but, will it change anything? Politicians won’t do anything about it when big pharma is in their pockets and they’re scared of the insurance companies. 

Anyway, he says that doctors’ incomes have been progressively on the decline for years. Can i get an ‘amen’ on that my people. Testify!!  He says this cash-strapped generation of physicians have been forced out of private practice into working for hospitals and huge conglomerates and that gone are the days of Wednesday off for golf, gone are the days of being called a doctor rather than a provider, gone are the days of being respected, gone are the days when patient’s would say “But what does the doctor say?” rather than “Will the insurance pay?”, gone are the days when a physician could direct care they deemed necessary. Even the prescription pad is becoming useless since insurance doesn’t cover a lot of the scripts written these days. 

He says gone are the days when a physician could sit down and perform a detailed and thorough examination. Instead, we have be busted down to being typists, chaotic clerks, mindlessly clucking away at meaningless electronic health records benefiting only large entities. Hallelujah!! 

In order to make money these days, it has to be quantity and, unfortunately, quality many times suffers. For better or worse. When your income goes down, you see more to maintain the income you have built your life around. Quality of care suffers. Not intentionally. Nobody is morally corrupt typically. It’s just a natural consequence. You have bills to pay and you’ll figure out a way. 

Take a radiologist. They used to get about $35 for reading a neck series. Now, after Obamacare, they make $7-$10. I happen to know a radiologist very well so you can trust what I’m telling you. At least here in Texas. Could be different in your area. What happens when you income gets reduced by roughly 2/3 but you still have a big house and some extra toys you have purchased? 

Maybe you have a big garage sale and get rid of the extra fat? Ah hell no, that’s not what happens. Instead of 5 films read in 30 minutes you read 10. Think you might have an elevated risk of missing something? Of course you do. 

Back to the article….I keep getting side-tracked, he says gone are the days when a physician had the luxury of utilizing their skills of observation. He says now there are cookbook guides that have become the puppet masters of the physicians. I’d like to go on record right now, as part of a profession that has no standardization whatsoever…..I’m all for researched and evidence-backed guides. I love it. Give us some guides. Hell, don’t just give them to us, FORCE us to abide by them. Please? Lol. Just make sure they weren’t generated by a damn insurance company. That’s all. 

He says gone are the days of decent hospital stays and the days of when a patient could be cured of infections from a decent stay at the hospital. Now, he claims that patients are kicked out of the hospital early and take the buggies back to their community and spread them which leads to resistant buggies. I’d argue that commonly prescribing antibiotics when it’s a virus was problematic and the cause of a lot of resistance back in the day as well? He left that out oddly enough. 

He hit on a HUGE one when he says gone are the days of reasonable costs for a doctor visit or a drug co-pay. Now, since Obamacare, we see double and triple premiums, up to $100 co-pays, and double or triple deductibles. 

This sucker continues but, before I get to the rest of it, I need to talk about one of our amazing sponsors here at the show. It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

Back to the article, Mr. Weiss says gone are the days of visiting an ER and getting immediate care as if illness is the priority. Instead, we gotta get that co-pay covered first. 

He claims the days of physicians not having to worry about a patients insurance are gone. But…haven’t those days been gone since the 80’s or so? Honestly? That’s not something new. He says though that the insurance companies have encouraged minute clinics where the nurse pracs, and he says soon the pharmacists, will be giving the medical advice. 

He doesn’t seem to like this idea much but he’s OK with people waiting for hours to see a ‘physician’ because there aren’t enough of them. I’m pretty OK with nurse practitioners for the more mundane stuff. Plus, in my experience, NPs are more likely to refer to chiropractors for whatever reason. 

While Mr. Weiss is right to some extent, a lot of this is just whining in my opinion. The traditional physician doctor had their run with all of the power, the glory, and the golden ticket they cash when they get their medical degree. And, to an extent, they damn well still have a certain amount of power, glory, and golden ticket status. Although to a lesser extent currently. Admittedly. 

It’s one of the last quotes of the article that gets my goat a bit. He says, “Physicians’ voices have been drowned out, their plights buried, leaving their patients helpless,,,,”

Well freaking whaaaa Weiss. Yes, chiropractic has the status it has in healthcare right now because a certain portion of its practitioners refuse to progress. In fact, they work to inhibit any progress and cripple any efforts to expand the profession. Yep, it’s there and it’s undeniable but, when we talk about having voices drowned out, plights buried, and helpless patients, let’s go a little deeper. 

I’ve said it a million times but the medical field is going to look back on spinal fusions in 20 years and wonder what the hell they were thinking. I think I heard where lumbar fusion surgery has gone up 500+% in the last decade or so with little to zero hard stats that show any improvement in outcomes. 

Oh looky there, I see a herniation. Let’s cut that out and you should be good as new. We know so much more now. We know you can’t cut out pain. We know you don’t treat an image. You treat the patient in front of you because most of the time, there is little to no correlation between what you see on an x-ray and what the person’s pain generator is. 

We know now that chronic pain is mostly in the central nervous system. Not out in some peripheral part of the body. You cannot typically get rid of chronic pain by cutting something out. We know more and more now that it just doesn’t work that way. 

Yet, I feel confident promising you that right now, several fusions across the country are taking place. As I type this out. We also know that less than half of those fusion surgeries will be successful, right?

We know this stuff. Yet, they continue. Unabated. So, while I agree that insurance, the government, and the whole managed care concept have screwed up our healthcare system, I would say that physicians have played very key parts in their own downfall. Hello….opioid crisis anyone? Unnecessary surgery? Surgeries for the wrong candidates? Super bugs from overprescribing? Any of this ringing any bells? 

Have you heard the podcast called Dr. Death? Basically, a so called spinal surgeon down in Plano, TX maimed several patients and even killed several and the hospitals protected him and enabled him to keep hurting people over and over and over again. 

It’s not just insurance companies and big pharma that has cause any fall from grace. And let’s be clear, I don’t think there’s been a fall from grace. Go to a hospital and see the interactions. Everyone still defers very clearly to the physician and I don’t see that changing. It’s just now they have to work more, follow rules, and get paid less. I think that’s the big gripe. 

And to that I’d say, welcome to my world friend. Welcome to my world. 

But again, it’s not just the system. Medical doctors have done their part. And, as a chiropractor, I’d argue that part of that is they have largely ignored the American College of Physicians’ recommendations to try spinal manipulative therapy, exercise, massage, acupuncture, yoga, thai chi, and heat first for back pain. 

Those are the first-line recommendations and they are in concert with The Lancet papers on low back pain, the CDC, the FDA, the Joint Commission, The White House, and just about anyone else with any sense at all when it comes to non-complicated musculoskeletal pain. Yet, as I said, fusions are going on all over the country right now. As I speak. That’s when only 5% of back pain sufferers truly need surgery. 

When does someone truly need spinal surgery? When they hurt? Nope. Not usually anyway. Remember, you can’t cut pain out. Outside of an obvious case of a spinal fracture, tumor…..the bad bad stuff….I think it’s commonly accepted that surgery is necessary in a loss of bowel or bladder function, saddle anesthesia – cauda equina- type stuff, or a progressive neural deficits. 

So, if only 5% of back pain sufferers truly need surgery, why are so many still happening every day? After all of the research and after all of the updated recommendations?

Well, I’d say it’s financial. Get this, according to the American Medical Group Association’s Physician Compensation Survey says their research spine surgeons make $688,500 a damn year on average. 

Me personally, I’m doing pretty well in practice. But, it took me 16 years before I really started putting the pedal to the metal. Now part of that was my fault because I was traveling around playing music. Part of it was chiropractic’s fault because we have a system that eats its own. 

Either way, check this out, it took me 16 or so years to really build but, for an orthopedic surgeon, during the first two years of employment, bring in $400k and by their third year, $670k. Allied Physicians reported the maximum orthopedic spine surgeon salary was $1,352,000. 

Crazy. We have some chiropractors that make that kind of money but it’s not many and it’s not very likely. 

Anyway, I agree with some aspects of the article. Other aspects make me chuckle because, although it’s to a much lesser extent, physicians of our day are dealing with some of the things we’ve been dealing with for years and years. 

If we could just communicate with them the fact that we evidence-based chiropractors can play such a big part in helping them treat their patients and getting them back to work and back to life, I probably would have more sympathy. 

Hell, people come to us because we’re experts in what we do, because we are safe, and because we’re effective but, a large part of the medical field looks at us like stumbling idiots playing doctor and hurting our patients. While that may be true for some in our profession as well as for some in THEIR profession (hello Dr. Death), for the most part, we are all highly educated, highly capable doctors getting patients well. 

Maybe when they begin seeing us in that light, we start to see some sort of deeper, more meaningful integration. It’s started here and there in some pockets of awesomeness but not in general. It’s still a goal worth chasing. 

That’s assuming we chiropractors can get our of our own way. Otherwise, if I were a medical doctor, I wouldn’t want any part of something I could only explain as pseudoscience. I WOULD however be interested in a healthcare discipline that had the randomized controlled trials backing the meat of their modality. Count me in on that. 

And that’s the way I see it today. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Weiss M (2019). “The old days of medicine are gone.” Medpage Today – KevinMD.com.

Closing Patients – Helpful or Destructive?

CF 088: Closing Patients – Helpful or Destructive?

Today we’re going to talk about what closing patients in chiropractic is, we’ll talk about where it comes from, and we’ll talk about if it’s a positive or a negative. Plenty here to be provocative I must admit. Listen up and then make up your own mind. 

But first, here’s that oh how sweet it is bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back with some important information to make you better which makes your patients better. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #88

No research today. Only Opinion. I didn’t even include any sponsors in this episode because it might be seen as controversial to an extent and, if there’s some sort of uproar, I don’t want them in the crossfire. Now….

I believe the business of being trusted and an authority of sorts is to be objective. Regular listeners have heard me talk about the medical realm and failed surgeries, etc. I state over and over that I am a chiropractic advocate. 

I am an advocate. Just listen to all 87 previous episodes and you will clearly see where I stand on the big stuff. BUT, if we do not have the ability or the honesty to police our own, then we’ll never be able to pull out of red-headed step-child status. 

We will forever be ridiculed and mocked. And that’s because the bad apples spoil the whole basket. 

It’s been a while since I’ve been able to just do a brain dump on a certain topic. I think the last time I did that was back when I talked about religion being brought into chiropractic.

I’ve been seeing more and more terminology like this lately and it’s time to address it and meet it head on. 

Let’s get something perfectly straight here: I’m about to piss some people off. Let’s also be clear on the fact that I’m already pissed off so I don’t give a damn if I do. I have been for a while. It’s been stewing and simmering and, after a while, it’s time to talk about it. 

Hell that’s the whole point of having a podcast. Promote what I agree with and find value in and spotlight cockroaches when I identify them. Having a platform to sound off on has been so cathartic. You have no idea. It helps in so many ways. It’s probably why I don’t have to go to therapy. 

As I have said, I am seeing the term ‘closing patients’ more and more and you know what? I’m mostly seeing it from wannabe gurus that aren’t even freaking chiropractors!!! They are trained at spouting their horns and touting their skills but never bought in enough to actually be a chiropractor. No, they just prey on chiropractors. 

Does that register? Closing patients! They’re fine with the term closing and the idea because it’s not their profession, their profession is marketing, so what the hell do they care if they trash the profession and whatever reputation we have scratched out? As long as they continue to fool well-meaning chiropractors into paying them, they don’t give one single damn what it takes.

As I said, the real unfortunate thing is that they go around jazzing up actual real chiropractors to the point that now many chiropractor actually think closing patients is a good and an acceptable idea.

Here’s the thing: it’s black and white. There’s good and there’s evil. There’s right and there’s wrong. Closing patients is straight up 100% wrong. And in my opinion, borderline evil.

I posted on our private Chiropractic Forward Facebook group the other day asking for opinions on closing patients. Good, bad, pros, cons, etc.… I value our tribe and their wisdom.

For a more general opinion, I asked in the Chiropractic Facebook group. That’s what it’s called…..just Chiropractic. You’ll find birds of all feathers in there so I figured I’d get some crazy answers and some in the middle answers. 

I really didn’t though. It seems that most, if not all, were essentially against the idea of closing patients.

Here’s what I got. Some that I highly respect say that if you’re NOT giving good solid recommendations and the telling them what it costs, then you’re not doing your job. 

One colleague wrote that patients want a doctor. Not a friend. Damn straight.

On this, all of us absolutely agree. 

Although a report of findings and recommendations and a financial talk could be viewed as closing patients,  that’s not necessarily what I mean when I refer to closing patietns. Not in my mind anyway. 

Being a doctor certainly comes with the responsibility of telling patients what you think is wrong, what you think they should do to fix it, and how much that would cost. That’s just being an ethical professional regardless of what business we are working in. 

I’m talking about manipulation of information and manipulation of emotions to get a desired effect that benefits the practice more than it benefits the patient. That’s what I’m talking about.

There was a reason I never really got down a good report of findings. It’s because I never felt comfortable with it. It never felt right because it wasn’t me. So I just went to what felt right. That doesn’t mean those of you that are good at a report of finding are doing something bad. I’m referring to a closing patients sort of ROF that I was once force fed. That’s what I’m talking about. 

What felt right was telling patients what I think, what I recommend, asking them if they have questions, and then getting started. It’s pretty damn simple honestly and I have more patients and business than I can handle. 

To tell me that my only way to succeed is to learn tactics and manipulation, we just have to disagree. Our values are not in alignment. Adjust that won’t you? 

I heard one guru say that our job is to identify or uncover what the patient’s pain is keeping them from doing or accomplishing and then leveraging that information against them by focusing on that shortfall in order to make a sale. To get a desired outcome.

Really? That’s what my job is? Are you sure? Because I thought it was to give my patients the very best recommendations that I can based on education and experience and then be there to help and guide them regardless. All these years and I was getting it wrong. All I needed was this 20 something person to help me get it right. Insert eye roll. 

When closing patients in chiropractic, he says we NEED to be focused on it. For example, if a patient comes to us with back pain, that’s not what we need to focus and work them over about. No….we should be working them over about what the back pain keeps them from doing…..THAT’s what they really care about so THAT’S what we pounce on like a grizzly on a salmon.

So, uncovering the ‘pain point’ of a patient just isn’t something I think smart, capable, educated doctors should be concerning themselves with. It’s called morals and ethics. 

They act like being unethical builds the fat wallets so that the fat wallets can further chiropractic. So…..I don’t want that kind of chiropractic being furthered. At all. Not a millimeter. Ever. I want it to die and go away never to be heard from again. 

A previous guest on our podcast, Dr. David Graber up in New Jersey is literally one of the smartest people I know and he had this to say about it, 

“When the Chiropractic profession started relying on business and sales techniques for practice building they did use approaches to ” close the sale” of care to patients. 

It’s a transaction- based approach with a winner and a loser. It’s positioned the doctor-patient relationship as a competition or Confrontation. This became especially prominent with long-term care and prepayments plans.

The alternative is open the relationship rather than close the sale, because there’s nothing to sell. A report of findings now is exactly that, a report of findings and options given. Respect for the patient’s autonomy in decision-making and service over sales. It’s becoming a partner not a competitor with our patients.”

He’s so damned smart. I wish I could have the eloquence to put things the way he does. He makes it look easy. 

What he’s talking about is being patient-centered, not doctor-centered. That’s really the whole point of the whole damn episode I think. Being a partner with our patients is being patient-centered. Not dominating them through whatever means necessary.

If you think some chiropractors’ shenanigans aren’t making it online? You’re crazy. People are posting it everywhere. Names, dates, events, quoting the doctors word for word. Things don’t happen in a vaccuum anymore in the year 2019. 

Here are a couple of stories I found on the interwebs while researching this episode about closing patients. 

This first one is an experience a woman had when she visited the chiropractor. Luckily, she didn’t swear off chiropractors completely after the experience but who could have blamed her if she did?

She preframed this sucker as a cautionary tale to all those who are easily persuaded by emotional sales pitches. She went to a fair and got on one of those spine check doohickeys that checks balance from one side to the other and high shoulders and all that crap. 

The lady told he she was carrying 9 more pounds of weight on one side of the body than the other and her head is 2 inches too far forward and one shoulder is higher causing her head to tilt the other way to compensate. 

All of the sudden, a care-free girl out shopping at the town fair who stopped to have her spine checked for a little fun change-up in her daily routines is thinking, “Oh damn…this sounds awful.”

No worries though, the chiro office offered her a $20 preliminary screening at the center to include 2 x-rays, a spinal exam, a foot screening….the whole shubang, for $20. Awesome. Way to value your services random chiropractor screening at a town fair that has nothing to do with health.

Luckily for this lady, her husband smelled a skunk.  

She went to the appointment, paper work, intial intake with the staff, and then the chiropractor arrives. She asked if she could do a few more exams of the spine. Following this exam, she said in a grave voice that she has some serious concerns about the neck and spine. 

IN FACT, she would like to take two more x-rays than scheduled in order to check out a few other things. She reassured me that I wouldn’t need to pay for these x-rays — they would just send the bill to my insurance, and if insurance wouldn’t cover it, they would eat the cost. 

The patient thought WOW, they must really care about the well-being of their patients to take this financial risk! 

Then, sent home with a follow-up appointment scheduled. Not before the chiro reminder her how urgent it is for her to come back and get treatment started as soon as possible. Makes me want to pull what is left of my hair out of my head. 

She left that first appointment sincerely afraid that there was something seriously wrong that only chiropractic was able to fix. She was leaving that first appointment basically in tears. She didn’t sleep at all that night. She was thinking, “What if I lay with my hnead at the wrong angle….would that make her neck even more crooked?”

Follow up appointment, seated in an education room when whe underwent a lesson in the philosophy of chiropractic. They told her that by the time we feel pain, our bodies are down to 40% health which means that if we feel healthy, we really aren’t. Holy guacamole. Crap fire and just save the damn matches won’t you?

All of our illnesses come down to subluxation which only chiropractic has the answer for, blah blah blah.

Then the x-rays. These are her exact words, “First we looked at the before and after x-rays of people whose lives and health were transformed at the Wellness Center. 

Next we compared *healthy* spines (people who have regular readjustments) with *unhealthy* spines (people who just don’t care about their health and don’t want to live past 65). 

Finally, we looked at the x-rays of a few tragic people who did not get the treatment they needed and whose spines were COMPLETELY COMPACTED. Dr. Amy then asked if I was ready to go look at my films — and I responded by bursting into tears.

She goes on, “When I saw my x-rays, my first thought was, “Wow, it’s not as bad as I thought! My spine doesn’t look like a 70-year-old!” But still lurking was the shadow of what might be — the ghost of future spines, if you will — if I didn’t pursue a full chiropractic treatment plan. 

Dr. Amy and I talked through my x-rays, and I learned that my spine is only at stage one degeneration (something they NEVER see in a 28-year-old!) — in other words, still terrible, but treatable. 

By this time she was fully convinced that 

  1. I needed chiropractic care, 
  2. it should start right away, 
  3. this Wellness Center should be the one to offer this care, and 
  4. it would save my life.

Guess what she got….you just guess! That’s right, she got a 12-week treatment plan, 3 visits a week for the low low basement bargain price of $2,800. 

The office, because they’re so giving and kind and genuinely caring offered her an 18-month payment plan at $140/month. For treatment she didn’t even need in the first damn place!!

Remember, even if you don’t hurt, you’re still sick? Good Lord jumpin’ jehovah. The lady told the doc that she needed to run it by her hubs before signing a contract. Like a contract belongs in healthcare in the first place but whatever. It’s outlawed now. At least in Texas. 

Anyway, the doc told her to come back the next day with her husband so that he could get a free screening with x-rays as well. Lol. These people. The hubs wasn’t buying it. She couldn’t believer her husband wasn’t more concerned that she was 28 years old and already had stage I degeneration of her spine!

He talked her down, she went and finally did some of her own research, and realized she had took a big swig of the snake oil. 

Yes, of course chiropractic could have helped her with her neck that had been a bit sore recently. Yes, a chiropractor’s office was exactly where she belonged. But no, not in an office like that where she was manipulated emotionally and almost financially. 

Here’s a lovely ditty about one of those beloved ‘free dinners with the doc.” Ugh. That’s a whole different episode, isn’t it?

Anyway, here’s what happened. the first thing is that the flyer advertising all but hid the fact that a chiropractor was the presenter. 

Quoted in this article was Robert Puleo of the California Board of Chiropractic Examiners. He said, ““It reeks of snake oil. There are some chiropractors out there who want to make a buck any way they can.” And: “The chiropractor holding such seminars tries to sign people up for months of office visits that can cost thousands of dollars.”

Ummm….yes. Exactly. You think chiropractors keep buying dinner because they’re nice people? Hell no. They’re trying to scare people into a close and a sale. 

The attendee to the dinner mentioned in the article said it consisted of four parts:

  1. Trust building – that’s where the presenter talks about their education and why they’re super double awesome and should be trusted. Can I just say that I immediately do not trust someone giving a free meal to prospective targets? I just don’t. Regardless of education. 
  2. Medicine bashing – This is where they talk about the inefficiency and poor quality of the US healthcare system. You all know the dance. I know that waltz myself. I can tell you all kinds of numbers and frame out the inefficiencies in a bunch of different ways. When it’s there, it’s there and I don’t mind that dance because they don’t mind bashing on chiropractors all of the time. 
  3. The product being sold – he was selling some laser therapy for neuropathy. The same stuff I believe that I just saw where an LA doc was on TV being accused of selling stuff that doesn’t work. Guess what? That dude was selling at a free dinner as well. I just never wanted to be a salesman. I just wanted to be a doctor and help people. Maybe I’m crazy. 
  4. Recommending consultations – Basically come see me at the office for $29 so I can sell you on thousands. Whne the attendee asked how much the laser service costs, he was told, “Oh, the doctor sets that amount.” So…..you can’t just tell me the cost? And…is there a dual fee schedule? Like, the doctor sets different costs? Because it it’s not a dual fee schedule, then the price is already set and, in that case, you should be able to simply tell me the price. Right?

I guess being upfront, transparent, and honest doesn’t quite fit into the dessert menu does it?

Last thing I’ll touch on is the RELIGIOUS ROF – For a more extensive exploration of this, listen to episode #61 of this podcast. It covers it at length but, in short, I’m a Christian so let’s not think I’m an atheist bashing on Christians. That would be a biased discussion wouldn’t it?

This is a non-biased discussion about it so settle down fellow Christians. 

Here is a script from a management company that uses or used a person’s faith against them to close a sale, ““Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

You can’t make it up and, as a Christian, I find it dissappointing to say the very least that a fellow Christian would think this sort of manipulation and sales tactics is permissable in any way, shape, form, or fashion. 

It’s just awful. All for the sake of closing a sale. Are we really that desperate? Obviously some at least think they are and maybe there’s no other way to make money. 

You want to know how to build a company? How to build trust in a brand? I’ll share it right here. Instead of the religious manipulation script I just read, say this:

“Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

See how simple it is?

Look, we all want to get rich while we help change the lives of our patients. But where does the switch happen where it’s OK to work patients to the point of emotional breakdown just so that they’ll sign up for countless visits over the course of a year or more? How does that switch go from being a new doc excited to work with the population into a manipulative street corner huckster schooled in the art of emotional manipulation? 

How does that moral compass get swapped approximately 180 degrees to the point that money is more important than superior patient care? And….reputation. I would argue that your reputation absolutely precedes you. Especially the smaller the town or area that you practice. 

One of my very respected colleagues, Dr. Gregg Friedman, who also happens to be a nationally known speaker, shared this thought with me when I asked about closing, “Closing a patient” looks like a sales technique and makes me want to puke. It does not create a positive image of chiropractic in the minds of the public we strive to serve. Just my opinion.” Spot on, nailed it. 

There are about 45 chiropractors in my area give or take. I know how about 80% of them practice because patients tell me. I’ll bet about 80% of those chiropractors know how I practice. For better or worse. I say worse because they only see my failures and I only see theirs. BUT….we still have a general idea of who the chiros in our area are, how they practice, and if they’re reputable. 

Basically, would you send you brother, sister, or mom to them? How about your child? If you’d send your family member to yourself, maybe you’re in a good spot. I can’t answer that. If you have systems set in place that manipulate information, manipulate a patient’s emotions, and manipulate words to make the practice a lot of money……and you’d still send you kid to that…..we need to talk. 

Let’s dive in a little bit more. Now, those of you that use this, and firmly believe in it, are going to be pissed right now. 

“Who the hell is this guy, what make him think he can question this or that, blah blah blah?”. I’ll tell you who I am. Nobody particularly special is who I am. In many ways I’m no smarter than the people that use some of this stuff. In some ways I am. 

I’m a bit of a research nerd – a dude with what I like to hope is an EDUCATED opinion and I’m a dude with an opinion that just happens to have figured out how to record and air podcasts, build a crowd, and talk about his opinions. That’s all. If you don’t like my opinion, go get your own podcast and crowd, go figure that out and talk about what’s important to you. 

There are already lots of them out there. Go call your company something like Chiro Closers, hustling chiros, chiro shrimp, or cervical correction academy specialist association or whatever the hell you can come up with that gets attention, or sounds important. Hell, I have half a mind to buy the domain www.chiroclosersareus.com and just have a landing page that says, 

“Hey, welcome…I’m not selling you anything. I just want you to know that closing people in healthcare is not patient-centered, it’s not quality care, it’s not being the doctor that you are, and you can be just as successful if you be the doctor, diagnose well, make good responsible recommendations for care, be a partner with your patient in their recovery, be sincere, really really care about them, and then be there however they decide they want to use you.”

Bam….secret to success nugget. 

Right there. If you didn’t listen or zoned off, rewind that about 15 seconds. You don’t have to buy it packaged up a million different ways from wannabe gurus. It’s really so so simple folks.

Back to the point: One of the most common reasons for big money, long-term plans I hear from patients when we’re talking about their previous chiropractor was that they saw an x-ray of their neck and it was straight. And to get that curve back, it was going to take 65 visits over 14 months at a cost of $4,500 (I’m making those numbers up but you get the point). All to get that curve back. 

Now, can we be honest a sec? You can go tell me to jump in the river. You can tell me I’m only about treating pain..and you’d have a fair point… You can call me a medipractor. You can call me whatever names you like but be serious, thoughtful, and maybe even non-philosophical for a minute. 

I believe, and my experience suggests, that a straighter curve is a consequence of simply being alive for a whole bunch of years. I believe that not having a curve when a patient is 50 years old is NOT going to impact their lives so much that they need to pay me as much as a surgical co-pay would be for surgery? What if I improve the curve a few degrees? Is it really that big of a deal that made that big of a difference?

The ONLY research I’ve seen on straight necks that made much sense was more recent. We covered it here on the podcast. It said it may lead to some degeneration of I believe it was C6/7 but, overall, impact of it was minimal. 

Other research you may have seen on this may come from other gurus that have conducted their own research. 

How nice is it to be able to say you conduct your own research, not have it peer reviewed or published in any respected journals, and then say it backs up your method so that people buy your products? That’s nice. Funny how that stuff works right? And so convenient. 

THAT’S what I mean by manipulating information. 

Let’s re-visit the title of this episode. Just repeat it a time or two. Closing patients. Let’s add a couple of words. Closing patients on care.

For me, that’s an oxymoron. If you care, are you going to manipulate patients with words and emotions? The correct answer is hell no you’re not.

Put yourself in the patient’s place real quick. 

Do you, in a healthcare setting, EVER wish to be closed? Other than an incision of course…. as my good friend Dr. Tyce Hergert in Southlake, TX says. Lol. 

The answer is no. At least I sure as hell don’t want to be closed. Not under the fear of losing my ability to function 30 years in the future. Not under a fear like that that no research I’ve ever seen can back up. 

As mentioned above, you want to be told what is wrong, you want to know how to fix it, and you want to know how much that costs. You might be interested in any other treatment options as well. You might want to know if you could just undergo a trial period of treatment first to see how you respond to care before deciding on anything else.

ALL OF THOSE should be on the table and your patient should know that, at the end of the day, your job is to be the doctor and give them your best recommendations while also understanding that you are there to help them to the best of your ability regardless of what they decide. 

Again, we should be our patients’ partners, not their boss, not dominating them, not running the show regardless. 

In the end, remember the three pillars of a patient-centered, evidence-informed practice. They are of course, 1) the best external evidence, 2) individual clinical expertise, and 3) get this…..pay attention….patient values and expectations. 

Not the doctors values and expectations. 

Key Takeaways: be a partner with your patients. Do not be a domineering, street corner snake oil salesman. Please. Those that do this give all of us a bad reputation. I have gone through the DACO diplomate program. Countless chiropractors around the globe highly educate themselves and take great pride in the results they can get for their patients. 

When you go about business like we’ve been discussing here, you discredit all of us almost immediately in the minds of those patients. Who then turn around and tell their family and friends and then go and post it on their blogs or tell a TV reporter about it who then tells everyone in the world in one way or another. 

Cut your crap. Enough is enough. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

w/ Dr. Kris Anderson – FQHC, Chiropractic Research, and Professionalism

CF 079: w/ Dr. Kris Anderson – FQHC, Chiropractic Research, and Professionalism

Today we’re going to be joined by a special guest Dr. Kris Anderson from North Dakota. Yes, North Dakota’s finest is here to tell us about some of the stuff he’s got shaking and there’s a lot of stuff shaking thanks to this amazing guy. 

But first, here’s that silky satiny bumper music

Chiropractic evidence-based products

Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #79

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. I just got in my first box. I started with the non-surgical spinal decompression brochures. I wanted them for myself and ordered enough to send you some too!

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

DACO

Let’s talk a bit about the DACO program. I’m still studying. Nothing sexy there. I will say that the second time through the material is really really valuable. At least for me it is. I forget so much. Especially being 46. Not only am I older and I don’t remember things at the level I once did, but I also think I’m undiagnosed ADD. 

If I see anything shiny, man, I’m off in a completely different direction. When you have computers and phones dinging at you all the damn time, it’s tough. I have tried to minimize my notifications on the electronics. I’ve tried to keep my phone turned to do not disturb and all that good stuff. I can’t deal with all the racket when I’m trying to focus on something. 

So, yes, the second time through, for me, is of high value. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Now, let’s get ot our guest today. 

Sometimes, we have doctors on as guests that not everyone knows. I think that if you do not know our next guest, you either should or will know him in due time. He is a mover and shaker in our profession and is really just getting started. Some people cannot be ignored and I think our guest is one of those. Without a doubt. 

He is the current President of the North Dakota Chiropractic Association and was voted Chriopractor of the Year last year for the NDCA. That’s a pretty big deal. 

He has worked on behalf of the State of North Dakota with payers, legislatyors, government agencies, and other healthcare and community stakeholders. We’ll be finding out more about that in a bit. 

He has helped conduct research on safety as well on a smoking cessation pilot study.  

He was part of a study team whose systematic review of manual therapy for pediatric patients was published in BMC Complementary and Alternative Medicine. 

He treats part time as an employee of his local FQHC. Which stands for Federally Qualified Health Center. He’s their first chiropractor so I can’t wait to learn more about how that is progressing and what challenges he is encountering as he goes. 

If all of that were not enough, he is currently the AMA RUC HCPAC ACA Alternate Advisor. Don’t feel bad if you don’t know what that is because I had to ask too. We’ll tell you about it. Some of it is super double top secret but interesting for sure. 

He is also in the middle of a North Dakota Department of Health grant to help expand detection and management of hypertension within our profession. 

Now….now do you see why we have him here with us today? You may or may not know the name Kris Anderson but I feel confident the entire profession is going to know who he is by the time he’s done leaving his dent on our profession. 

We are happy to welcome Dr. Kris Anderson to the Chiropractic Forward Podcast today. Thank you for joining us today Dr. Anderson. 

My first question for you is, “When the hell do you ever sleep?” You have a ton of stuff going on.

I noticed on your CV that you worked as a barista at Starbuck’s during your time at Palmer. I’m not sure how anyone can hold a job while going through chiropractic college but, is this a skill that has paid off for you? Do you have an espresso machine in your office?

When I go through your information, you are involved in so many things. For example, I see your are District 4’s representative for Clinical Compass, Delphi Panelist, Grantee from ND Dept. of Health, Committee member for Notrh Dakota State Board of Chiropractic Examiners, ACA, and on and on. Where does all of this stem from? I’ve never even considered district representative for Clinical Compass was even a thing. Lol. 

We covered a paper you were part of back in Episode #68. In fact, that may be how we became familiar with each other. The paper was callled “Manual therapy for the pediatric population: a systematic review. It was in the BMC Complementary and Alternative Medicine(Prevost C 2019) just this year. I want to know all about it. How did you get involved with the team? Tell us a little about the process. 

This study came out at just about the same time as the Australians and certain spots in Canada started dealing with attacks on their rights to treat pediatric patients woith chiropractic care. What amazing timing. First, are pediatric patients a significant part of your practice and secondly, what has been the reception globally in regards to the paper’s findings?

As you probably well know, Texas has been in quite a battle with our state medical association. You are clearly as deeply involved in your state’s association. What challenges are the North Dakota chiropractors facing in 2019?

Do you have any specific goals to work on as President of the North Dakota Chiropractic Association?

Tell me about the gig with the FQHC? Dr. James Lehman was on our podcast in episode #55 and he was discussing the FQHC’s and integrating. He felt integration into them would be helped by completing a specialization like the DACO or something like that. What is your opinion on that? How did you get involved? 

What does your day at the FQHC look like?

Being the FQHC’s first chiropractor, what biases or other issues are you finding yourself having to address and navigate?

Tell us more about the grant you are in the middle of for the North Dakota Department of Health? How did it come about? What is the mission?

Let’s talk about alphabet soup….. AMA RUC HCPAC ACA Alternate Advisor. I promise, almost no person alive knows what all of that stands for so do us a favor and break it down for us and tell me what the purpose is. What’s the goal and how does it help chiropractors?

Those of us that have been active know the difference between being a member and being an active member. What has it meant to you both personally and professionally to not only be a member of your state association but to also be active in it? 

When we are sitting in our offices in Amarillo, TX or in Grand Forks, North Dakota, Washington DC and the ACA seems far away and somewhat out of reach. What have you seen is an effective way to become active with the ACA on a national level?

What’s coming down the pike for you in the next 5 years and in the next 10 years? Where do you see all of your efforts headed. Or where do you hope they’re headed?

Thanks for joining us

Chiropractic evidence-based products

Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

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Twitter

YouTube

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https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography

Prevost C, G. B., Carleo B, (2019). “Manual therapy for the pediatric population: a systematic review.” BMC Comp Altern Med 19(60).

w/ Dr. Christine Goertz – Chiropractic Research, What Does The Science Say, And Where Are We Going?

Today, we have one of the giants of chiropractic research as our guest. I will go further into her background in a moment but we have Dr. Christine Goertz joining us today and, if you do not know who she is, it is time to listen up. Don’t you go anywhere because this is going to be an excellent episode full of great information. 

But first, here’s that “oh how sweet it is” bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have bounced your way into Episode #68 and we are so glad you did. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier. 

Store

Part of that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Guest Introduction

Christine Goertz, D.C., Ph.D., is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Prior to joining Spine IQ, she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. 

Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 25-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of complementary and integrative healthcare delivery.

She has extensive experience in the administration of Federal grants, both as a PI and as a program official at the National Institutes of Health (NIH). Dr. Goertz has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. Her primary area of focus is the investigation of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz is a former member of the NIH/NCCIH National Advisory Council and currently serves on the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI), where she has assumed numerous leadership roles. In September 2018 Dr. Goertz was appointed to a 3-year term as Vice Chair of the PCORI Board by the Comptroller General of the United States. 

Welcome to the show Dr. Goertz. I can’t tell you how excited I am to have on our podcast. 

Can I first ask you what was the impetus for your wanting to get into the research end of the profession? How do you come to the decision to dive into research full-time vs. treating patients day-to-day like so many of us do?

I noticed on your CV that you are currently an adjunct professor with the Department of Orthopaedic Surgery at Duke University Medical Center in Durham, North Carolina and also an Adjunct Professor in the Department of Epidemiology, College of Public Health, University of Iowa. All the while, you are working with The Pine Institue for Quality (AKA Spine IQ). Can you tell us what a regular day looks like for you?

Whether you know it or not, you have been a game-changer for this profession. You have, likely unknowingly, played a big part in some of our podcast episodes. I want to start with a paper we covered. I called it The Veterans Paper and it was HUGE. Though I call it the Veterans Paper, you say it was done as part of the Department of Defense. I wonder….did you notice anything BIG after it was published in JAMA? Was it, in your opinion, any more impactful than your other papers?

Here’s what happened as soon as that paper came out from my perspective; almost immediately, we began getting interest from our local VA and, once we completed credentialing, we started seeing referrals. Before that paper…..nothing. No interest. I don’t know if you’re ready to take all of the credit for that but I’m going to give it to your regardless. On behalf of the entire evidence-informed chiropractic profession, thank you for that. 

In emails we have exchanged leading up to our time together today, you mentioned you have a large pragmatic trial funded by the NIH in the VA. Can you tell us anything about that?

In your work called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain – Time for a Change” published in JAMA October 2015, you say there are no policies emphasizing nonpharma treatment at the forefront of the patient experience, no meaningful levels of coverage for care professionals focussing on nonpharma therapy, and no policies providing financial incentives in favor of nonpharma. I have seen your work make huge differences but have to admit, I’m still seeing reimbursements for chiropractors being a challenge. We have folks out here struggling in practice in spite of everything in our favor. Have you experienced any changes after this came out in JAMA? Can we expect these sentiments you describe to gather steam in the next year or so?

In another piece of yours called “What does research reveal about chiropractic costs?” you say something I want to commend you on. You say, “without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery.” I think we can all agree that standardization is likely the biggest hurdle our profession faces in regard to integration. Do you believe chiropractic residency training would better prepare chiropractic providers to offer high quality care within medical facilities?

I’m currently over 2/3 of the way through the Diplomate for the Academy of Chiropractic Orthopedists. I see the value every day but, in your opinion, should Board Certification become the norm for chiropractic providers rather than the exception?

In that same paper, when talking about costs for chiropractic care you point out that we are likely equal or less in cost. You say, “In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.” Do you feel that the medical field is coming to the point they are seeing our potential in improvement as well as our cost-effectiveness on more of a widespread scale or are there just little pockets here and there? Is the medical field starting to catch on but the insurance companies are still not allowing the change? What are you seeing on your end of things?

You recently were part of a paper that was published just this year, 2019, called, “Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.” I really have to talk to you researchers about trying to shorten the names of these papers. 

Anyway, you all concluded on that one that one session of chiropractic manipulative therapy had immediate effect of reducing the time required for asymptomatic special operations forces to complete a complex whole-body motor response task. Tell me….what are we looking at here? Where is this line of research leading future research?

I personally love it and think it has extremely high value so when I ask you this question, please don’t take it as a negative. Are you responsible for instigating the Palmer-Gallup Poll? What were the main goals for starting it and has it lived up to the original thought process behind its beginning? 

I thought this was an interesting question. A listener and member of our private group on Facebook, Dr. Trent Peng, suggested I ask you which chiropractic adjustment techniques are sufficiently evidence-based in the scientific literature?

In an article by Lisa Rappaport, called “Adding chiropractic to back pain care may reduce disability,” she interviewed you for the article. She had a quote in the article from you that said, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” 

The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.” 

The first comment I have on this is that I love the second quote because there is more and more information coming out about what part the central nervous system plays in regard to pain. Pain sensitization, movement dysfunction, joint proprioception and thing of that nature. I thought that quote brought some of that into consideration without getting too complicated for a normal reader. So, kudos on that!

I remember thinking to myself that there are a lot of “may help” and “it is possible” kind of language. I understand that researchers shouldn’t formulate opinions or conclusions in definite terms or absolutes and I completely understand that, but my question to this point is do you ever see a time that all chiropractors can say with a high degree of confidence exactly what happens and exactly why it helps people heal or feel better?

I was sent a paper I believe you have in progress called “Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for a randomized controlled trial. In the Background section, you all say, Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with low back pain.”

As you probably know, here in Texas, we are in a perpetual battle against the Texas Medical Association. Recently, they won a decision that was upheld on appeal to remove the ‘neuro’ snippet from our scope description of treatment the neuromusculoskeletal system. Essentially, they say we only treat the musculoskeletal system. With the research you have done and are currently involved in, what do you say to this?

What has been your favorite project or finding you have been a part of so far?

What has been your favorite paper, project, or finding that a colleague has written but you were not a part of?

What conclusion have you had to draw at the end of a paper that surprised you the most?

How do you see quality research translating into a greater level of inter-professional collaboration and how do you see the future of chiropractic unfolding in terms of integration into the healthcare system?

A tie-in question here, where do you see the profession in 10 years?

I know that low back is one of the biggest reasons for disability worldwide, if not the biggest. It deserves the attention it has received. We have research on low back pain now to the point that even traditional chiropractic detractors can’t really argue all that much with us on low back pain. But we still have a fight on our hands when it comes to cervical manipulation. My question is why do you think we don’t see more research for cervical manipulation and do you see the spotlight ever changing and the research beginning to focus on cervical manipulation and the benefits for neck pain and headache/migraine?

In the private Chiropractic Forward Facebook Group, we are curious….what are you up to right now? What are you working on? 

Apart from what you are working on right now, what are your goals in regard to research in the next 10 years?

Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. I truly believe that our profession is where it is and going the direction it’s going in large part because of you an d your efforts. 

And I thank you so much. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger